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#1111114 PERMITAPPLICATION BUILDING / MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION tri CITY bF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: ,,9 q -kICI Se.._- PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision __ ___ Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: J a S TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET a-06-�} p��9 -y£�'{1 b''7 L� L . ^) q y�y y J CITY -y1-1,.�J.'C,---'/ (.- Y_J STATE �,.�A. z,, L? ,?-&-- OWNER ;-4.- OWNER PHONE:/ J j - Lig-. I`—f OWNER EMAIL: CONTRACTOR NAME: V)C> Y DS f'Y) -Pc2.-211 L-/ j -- K4-L.',- CONTRACTOR ADDRESS: STREET I'7 / f 7---71/444"1- `" 'yl• ._-/ � _ 61- „, �% ! CITY x/)��,-yL 1�,)— V i J )Z _ STATE _TWA—A— ZIP 6N ��6 CONTRACTOR PHONE: o 00 -",:3 °1 gI'*ONTRACTOR EMAIL:-,;,4f., 0-1: I C CIT otth/D}ythe'z-*)h ,e,.- �, r CONTRACTOR LICENSE#(REQUIRED): / )O I'-e-/3J'}C(: 41-1,0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):i q? 74-/J PRIMARY CONTACT: 0 OWNER I:ONTRACTOR 0 OTHER(Please Specify) CONTACT NAME:I CONTACT PHONE: ( �a �0 bLf/ I- , rit}-12-'1061t.— CONTACT EMAIL:Z}'t-CI L'.--,.l1a)� 0 incri`� VL h a+-I 076 I C{,}, BUILDING PERMIT APPLICATION --� Existing Use of Building: Contract Price of Work:$ c72-40 Proposed Use of Building: Heat Source: Cas ❑Electric ❑Other Building Type: ❑SFR-Detached ;PSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ^Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: t_i_ie 0 t i r ,,` ,-1 .4.,)--via a v-t p) Q.c-e-p.Yr .1- ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) / Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or Water I INo.of Heads ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only ' ie.-7 -i'''/(Ciiiill"\` . (f-1 .- -- PERMIT# J C ry `� g —e4 (0 Owner/Authorized Agent Signature Date (Revised 9/23/2016)